Intravaginal cleansing practices among women attending a female pelvic medicine and reconstructive surgery clinic

Abstract

To determine the prevalence of intravaginal cleansing practices, the associated factors, and the relationship with vulvovaginal and urinary symptoms amongst women attending a Female Pelvic Medicine and Reconstructive Surgery (FPMRS) clinic. This cross-sectional study was conducted between October 20, 2019 and February 20, 2020. We included women aged eighteen and above who presented for a new patient visit to our FPMRS clinic. We excluded women who were unable to speak and read either English or Spanish and women with a history of dementia. The primary outcome was the overall prevalence of intravaginal cleansing practices among women who practice at least monthly intravaginal cleansing. We obtained baseline demographic and clinical characteristics, information regarding intravaginal/vulvar cleansing practices, vulvovaginal/urinary symptoms, as well as the history of treatment for urinary/vaginal infections during the preceding 12 months. Validated questionnaires including the Vulvovaginal Symptom Questionnaire (VSQ) and the Urinary Distress Inventory Short Form (UDI-6) were collected. Data was analyzed utilizing Student’s t-test and chi-squared test or Fisher’s exact test, as appropriate. Seventy-nine women were recruited in this study. The mean age was 61.1±14.5 years. Most women were white (75%), married (62%), born in the United States (81%), with a bachelor’s degree or higher (49%), with incomes above $100,000 (45%), non-smokers (93%), currently sexually active (53%) and not currently using vaginal estrogen (85%). Fifteen women (19%) reported current intravaginal cleansing practice. The most common reasons for intravaginal cleansing were cleanliness (100%), reducing unpleasant odors (58%), protection against infections (33%), and cleaning after and before sexual intercourse (42% and 25%, respectively). Vulvovaginal symptoms were significantly higher in women who currently perform intravaginal cleansing (19%) compared to those who do not (81%) (p=0.02). However, there were no significant correlations between intravaginal cleansing and sensation of vaginal bulge or UDI-6 score (p=0.78 and p=0.07, respectively). Moreover, urinary tract and vaginal infections treatment over the prior twelve months were not associated with current intravaginal cleansing (p=0.3 and p=0.98, respectively). Despite its potential adverse effects, intravaginal cleansing is still a common practice among women across various age groups. Vulvovaginal symptoms were higher in women who cleansed intravaginally, whereas urinary tract and vaginal infections were not associated. Larger and more diverse populations are necessary to more accurately determine possible associations with intravaginal cleansing.